Definition

Glossopharyngeal neuralgia is a rare disorder of the IX (ninth) cranial nerve. The glossopharyngeal nerve is the ninth (IX) of twelve pairs of cranial nerves (24 nerves total). Cranial nerves are nerves that emerge directly from the brain. Glossopharyngeal neuralgia is characterized by intermittent attacks of intense pain in the throat, tonsils, tongue, jaw, neck or middle ear, on one side. As with other facial pain syndromes such as trigeminal neuralgia, hemifacial spasm and atypical facial pain, episodes can last for a few seconds or for several minutes. An attack may occur only once, or a patient may experience frequent attacks that become increasingly disabling.

Causes

  • Compression of the glossopharyngeal nerve by a nearby blood vessel
  • Compression of the nerve by a skull base lesion
  • Tumors or infections of the throat and mouth can also irritate the nerve
  • Multiple sclerosis

Risk Factors

Age is the only known risk factor associated with an increased chance of developing this condition. Glossopharyngeal neuralgia usually strikes people over 40 and is somewhat more common in men.

Symptoms

Episodic, severe pain, along the areas innervated by the glossopharyngeal nerve:

  • Throat
  • Tonsils
  • Tongue
  • Jaw
  • Neck
  • Middle ear
  • Sudden drop in blood pressure
  • Fainting

Pain can be triggered by:

  • Speaking
  • Chewing
  • Yawning
  • Swallowing
  • Coughing
  • Laughing

Diagnosis

When glossopharyngeal neuralgia is suspected, often the physician will attempt to trigger an episode by touching the back of the throat with a swab. If the stimulation causes pain, the physician will apply a local anesthetic to the back of the throat and try the pain stimulus again. If pain is not triggered while the area is numb glossopharyngeal neuralgia is diagnosed. Further diagnostic tests include:

  • MRI or MRA of the brain
  • CT scan
  • Angiography
  • X-Ray
  • Blood tests

Treatment

The first line of treatment for this condition, as with other facial pain syndromes, is medication. Anticonvulsants such as carbamazepine and gabapentin or tricyclic antidepressants such as amitriptyline may control the pain. If drugs fail to provide adequate relief, there are several surgical options:

  • Microvascular Decompression which lifts the offending blood vessel off of the nerve
  • Rhizotomy (surgery to sever the glossopharyngeal nerve)
  • Percutaneous radiofrequency rhizotomy

Prevention

There is no known way to prevent glossopharyngeal neuralgia.

Disclaimer

Content generated and provided by Joshua B. Bederson, MD, Professor and Chairman of the Department of Neurosurgery at Mount Sinai. Some of the information contained in this article was adapted from the National Institutes of Health. Last reviewed June 2011 by the Department of Neurosurgery at The Mount Sinai Health System.

If you want to learn more about glossopharyngeal neuralgia and its treatment call the Mount Sinai Department of Neurosurgery at 212-241-2377.